Ashesh Halder

1 Introduction The age-old strategy of conventional right ventricular apical pacing as backup pacing or as a part of biventricular pacing has largely been replaced by the adoption of cardiac physiological pacing (CPP) recently. With the refinement of implantation technique, operator experience and shifting trend from His-bundle pacing towards left bundle area pacing, the procedural success has improved and the complication rates have reduced in the short and intermediate term follow-up.

Chronic right ventricular pacing can cause complications such as atrial arrhythmias and left ventricular dysfunction. Left bundle branch area pacing offers a physiological alternative, especially for patients with anatomical variations like dextroposition. This case demonstrates successful pacing despite anatomical challenges, highlighting the need for tailored pacing strategies in complex cases.